acute kidney injury after laparoscopic spay

RE: acute kidney injury after laparoscopic spay

Elenor Walsh — Fri, 10 Mar 2023 09:40:19 GMT

There was a post on vet voices on facebook about someone having similar issues, AKI after spay but as far as I remember was not laparoscopic.

RE: acute kidney injury after laparoscopic spay

Catherine Churchill — Tue, 07 Mar 2023 08:22:28 GMT

I have been performing lap spays for 12 years and performed well over 1000 and never had this problem. Pre med I use is acp and buprenorphine. Don't no if the medetomidine and lower BP would have an effect. The intra abdominal pressure sounds a little high to me. Usually we use 8mmHg for up to 10Kg, 10mmHg for 10Kg to about 22Kg then 12mmHg above this. I have never used pressures above 12mmHg. Whether the combination of dom causing lower BP and higher intra abdo pressure is significant I don't know. I can't find anything in the literature.

RE: acute kidney injury after laparoscopic spay

janine redman — Tue, 07 Mar 2023 00:19:09 GMT

A lot longer than a traditional spay in my hands .

RE: acute kidney injury after laparoscopic spay

Michael Woodhouse — Tue, 07 Mar 2023 00:09:42 GMT

[quote userid="13609" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/30597/acute-kidney-injury-after-laparoscopic-spay/240984#240984"]GA ended about 1h50min after induction[/quote]

That's so long........

RE: acute kidney injury after laparoscopic spay

Andreas Ege — Mon, 06 Mar 2023 18:52:35 GMT

[quote userid="12930" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/30597/acute-kidney-injury-after-laparoscopic-spay/240985#240985"]I'm sure the VMD would be happy to receive a report - CO2 put into a patient's abdomen for surgical purposes is not that different from sterile water injected into a patient. they take microchip adverse reports.[/quote]

Good to know. I'll try that.

Yes, so did we. Just couldn't find one. Intra-abdominal pressure was 12-14mmHg, even had machine checked if it is giving us correct readings, if I remember right.

Couldn't find any veterinary cases either, there's a few case reports in human medicine, though as far as I could see they all involved patients with pre-existing ckd. I've seen the vin entry, think they cite the same studies/ reports I found. Then there's a few studies mainly on pigs and rats finding various compromises on the kidneys including post-op oliguria and short term aki that resolved within a week, though some of those studies went up to 20, even 40mmHg intra-abdominal pressure and "surgical" times up to 6 hours, so not quite sure how clinically relevant these are for a normal lap spay.

But as we haven't reported them or published case reports I'm wondering a bit if it is more common than assumed and just nobody gets the time/ interest to write a case report up

RE: acute kidney injury after laparoscopic spay

Beats — Mon, 06 Mar 2023 16:29:17 GMT

Undoubtedly a cautionary tale of some sort. Thank y9ou for sharing.

I can't find any other reported cases.

Same surgeon and 3 cases would make me think that there is a reason.

"Laparoscopic surgery increase intra-abdominal pressure resulting in direct venous compression, decreased cardiac output and increases in renin, aldosterone and AVP sufficient to cause oliguria in human patients.¹"

https://www.vin.com/apputil/content/defaultadv1.aspx?id=7259246&pid=14365

I would have wondered if higher pressure of gas in abdomen, compared to other surgeons, could have been a factor? (If indeed that is possible to achieve - I have no practical experience using laparoscopy)

Alternatively, could it be a genetic tendency to AKI in a local dog line if not being seen in other clinics?

[quote userid="13609" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/30597/acute-kidney-injury-after-laparoscopic-spay"]If it were a medication I would file a suspected adverse reaction report[/quote]

I'm sure the VMD would be happy to receive a report - CO2 put into a patient's abdomen for surgical purposes is not that different from sterile water injected into a patient. they take microchip adverse reports.

RE: acute kidney injury after laparoscopic spay

Andreas Ege — Mon, 06 Mar 2023 10:57:26 GMT

Generally, I don't know most of the details without going through the records and not sure if anybody will remember the names of the first 2 cases. I'm not doing lap spays (during the "training" phase there were only a couple booked in on days I was operating, and by now everybody else can do them without an assisting vet and are likely much faster) and only got involved with the aftermath, particularly for the last case.

The last case was a 2yr old sprocker with a history of pancreatitis and food sensitivities, pre-op bloods were unremarkable though I'm not sure if there wasn't a glitch on the lab machine - albumin was 1, tot protein and glucose didn't run at all, can't see a repeat though would expect one was done. Previous bloods in June 22 (5 months before spay) had only mildly elevated urea, otherwise biochemistry & haematology wnl.
Pre-med was methadone & medetomidine, induction propofol, maintenance isoflurane. Metacam was given about 1h after induction though the actual anaesthesia chart only starts about 30min after induction. GA ended about 1h50min after induction, MAP never below 60.
Can't say anything about the details of actual surgery and colleague during the surgery has moved on. If remembering right not using clips but electro-cauterizer.
This one did develop rather severe kidney injury and 2 months onward clinically completely back to normal but would be in IRIS stage 2 CKD (I'd assume chronic by now) by bloods with a consistent urinary SG around 1.016 and been like that for the last 6 weeks.
Think the other 2 made a full recovery after a few weeks, though 1 of them went for referral before it got better.

All three were operated by the same surgeon, but internally couldn't find anything he would have done differently then the other vets doing lap spays and he's a good and thorough surgeon normally. *edit* Assume pre-med/ induction/ metacam was done same with other cases considering same surgeon, don't have a fixed protocol but would have been what most of us would have used if I'm not wrong. */edit*

Never seen a case of aki after traditional spays.

RE: acute kidney injury after laparoscopic spay

Jill Butterworth — Sun, 05 Mar 2023 18:42:25 GMT

Any surgeon effect or equally distributed?

Sequale?

RE: acute kidney injury after laparoscopic spay

Richard Carter — Sun, 05 Mar 2023 10:45:07 GMT

The usual questions- does premed include medetomidine, length of ga, NSAIDs peri- operative and if pre- op, how long/ together with alpha 2?

Then questions about the position of clips, separating the renal ovarian ligament, any heat in the abdomen?

RE: acute kidney injury after laparoscopic spay

janine redman — Sun, 05 Mar 2023 01:01:11 GMT

How serious an injury ?

RE: acute kidney injury after laparoscopic spay

Michael Woodhouse — Sat, 04 Mar 2023 21:09:59 GMT

Do you have a standard drug protocol? Not a fan of pre-op bloods, but were any done?

What breed?